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Comprehensive Comparison of Health-Related Quality of Life After Contemporary Therapies for Localized Prostate Cancer

From the Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor Veterans Affairs Medical Center; National Cancer Institute Special Project of Research Excellence in Prostate Cancer, Departments of Radiation Oncology, Surgery/Urology Section, Internal Medicine, Schools of Public Health and Nursing, and Cancer Center Biostatistics Core, University of Michigan, Ann Arbor, Michigan; and Departments of Urology and Health Services, University of California, Los Angeles.

Address reprint request to Martin G. Sanda, MD, 2916 Taubman Center, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI 48109-0330; email: msanda{at}umich.edu

PURPOSE: Health-related quality-of-life (HRQOL) concerns are pivotal in choosing prostate cancer therapy. However, concurrent HRQOL comparison between brachytherapy, external radiation, radical prostatectomy, and controls is hitherto lacking. HRQOL effects of hormonal adjuvants and of cancer control after therapy also lack prior characterization.

PATIENTS AND METHODS: A cross-sectional survey was administered to patients who underwent brachytherapy, external-beam radiation, or radical prostatectomy during 4 years at an academic medical center and to age-matched controls. HRQOL among controls was compared with therapy groups. Comparison between therapy groups was performed using regression models to control covariates. HRQOL effects of cancer progression were evaluated.

RESULTS: One thousand fourteen subjects participated. Compared with controls, each therapy group reported bothersome sexual dysfunction; radical prostatectomy was associated with adverse urinary HRQOL; external-beam radiation was associated with adverse bowel HRQOL; and brachytherapy was associated with adverse urinary, bowel, and sexual HRQOL (P .0002 for each). Hormonal adjuvant symptoms were associated with significant impairment (P < .002). More than 1 year after therapy, several HRQOL outcomes were less favorable among subjects after brachytherapy than after external radiation or radical prostatectomy. Progression-free subjects reported better sexual and hormonal HRQOL than subjects with increasing prostate-specific antigen (P < .0001).

CONCLUSION: Long-term HRQOL after prostate brachytherapy showed no benefit relative to radical prostatectomy or external-beam radiation and may be less favorable in some domains. Hormonal adjuvants can be associated with significant impairment. Progression-free survival is associated with HRQOL benefits. These findings facilitate patient counseling regarding HRQOL expectations and highlight the need for prospective studies sensitive to urinary irritative and hormonal concerns in addition to incontinence, sexual, and bowel HRQOL domains.

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